HomeMy WebLinkAboutSeptic Repair 678 Sullivan Avenue TOWN OF SOUTH WI N DSOR
,y f � BUILDING DEPARTMENT
J"
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
9 p ys em
Application No.
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property "_ft_4' t ;fit� Address of Owner'
2. Location of Property _ 76( �,, ��i ;IQ ,�. ��� p Lot. No.
3. Type of Structure /�d a,f P No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals �}_ Lavatories / — Bathtubs
Showers_ � Kitchen Sinks 4 Laundry Tubs Garbage Grinderl) Other_ O
6. Liquid Capacity of Septic Tank 1 / f Material of Septic Tank
-S
7. Soil Conditions: Type of Soil /Va Maxim 6
(Sand,Gravel,Clay,etc.)
yyum ground water table_
8. If not served by public water supply: Distance from Owner's well C� from adjacent wells dA( /
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test rZ 42/ hf Classification of soil_
11. Minimum square feet of effective seepage area required /S'z ao
12. Leaching System: Number of trenches Length -,Z.E D Width Total_3 6 d
Other
Signature a ��g����
( iifs eta ri1 r) '
(Sketch showing all minimum distances and other details required below)
m
96 �_
F
AD,4/V �
Ho vs r^
�v
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
ec